Nokea
The nurse will instruct patients about a possible systemic effect that may occur if excessive amounts of topically applied adrenergic nasal decongestants are used. Which systemic effect may occur?
- A. Heartburn
- B. Bradycardia
- C. Drowsiness
- D. Palpitations
Correct Answer: D
Rationale: Although a topically applied adrenergic nasal decongestant can be absorbed into the bloodstream, the amount absorbed is usually too small to cause systemic effects at normal dosages. Excessive dosages of these medications, however, are more likely to cause systemic effects elsewhere in the body. These may include cardiovascular effects, such as hypertension and palpitations, and central nervous system effects, such as headache, nervousness, and dizziness. The other options are incorrect.
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When teaching a patient who will be receiving antihistamines, the nurse will include which instructions?
- A. Antihistamines are generally safe to take with over-the-counter medications.
- B. Take the medication on an empty stomach to maximize absorption of the drug.
- C. Take the medication with food to minimize gastrointestinal distress.
- D. Drink extra fluids if possible.
- E. Antihistamines may cause restlessness and disturbed sleep.
- F. Avoid activities that require alertness until you know how adverse effects are tolerated.
Correct Answer: C,D,F
Rationale: Antihistamines should be taken with food, even though this slightly reduces the absorption of the drug, so as to minimize the gastrointestinal upset that can occur. Over-the-counter medications must not be taken with an antihistamine unless approved by the physician because of the serious drug interactions that may occur. Drinking extra fluids will help to ease the removal of secretions, and activities that require alertness, such as driving, must not be engaged in until the patient knows how he or she responds to the sedating effects of antihistamines.
A gardener needs a decongestant because of sinus problems and asks the nurse whether he should take an oral form or a nasal spray. Which of these is a benefit of orally administered decongestants?
- A. Immediate onset
- B. A more potent effect
- C. Lack of rebound congestion
- D. Shorter duration
Correct Answer: C
Rationale: Drugs administered by the oral route produce prolonged decongestant effects, but the onset of action is more delayed and the effect less potent than those of decongestants applied topically. However, the clinical problem of rebound congestion associated with topically administered drugs is almost nonexistent with oral dosage forms.
A patient tells the nurse that she wants to start taking the herbal product goldenseal to improve her health. The nurse will assess for which potential cautions or contraindications to goldenseal?
- A. Taking a proton-pump inhibitor
- B. Nasal congestion
- C. Hypothyroidism
- D. Taking an antihypertensive drug
- E. Sinus infections
- F. Pregnancy
Correct Answer: A,D,F
Rationale: Goldenseal is contraindicated in patients with acute or chronic gastrointestinal disorders and during pregnancy (because it has uterine stimulant properties). It should be used with caution by those with cardiovascular disorders. Potential drug interactions may occur with gastric acid suppressors such as antacids, histamine H2 blockers (e.g., ranitidine), and proton-pump inhibitors (e.g., omeprazole), theoretically because of their reduced effectiveness resulting from the acid-promoting effect of the herb, and with antihypertensive drugs (because of the vasoconstrictive activity of the herb). Goldenseal is potentially useful for sinus infections and chronic nasal allergies.
A patient has been advised to add an adrenergic decongestant nasal spray to treat a cold. The nurse will include which instruction?
- A. You won't see effects for at least 1 week.
- B. Limit use of this spray to 3 to 5 days.
- C. Continue the spray until nasal stuffiness has resolved.
- D. Avoid use of this spray if a fever develops.
Correct Answer: B
Rationale: Frequent, long-term, or excessive use of adrenergic nasal decongestants may lead to rebound congestion if used beyond the recommended time. The other instructions are incorrect.
A patient with a tracheostomy has difficulty removing excessive, thick mucus from the respiratory tract. The nurse expects that which drug will be ordered to aid in the removal of mucus?
- A. Guaifenesin
- B. Benzonatate
- C. Diphenhydramine
- D. Dextromethorphan
Correct Answer: A
Rationale: Expectorants such as guaifenesin work to loosen and thin sputum and the bronchial secretions, thereby indirectly diminishing the tendency to cough. The other drugs listed do not have this effect.